The biggest stories and talking points in the NHS from Tuesday

A grand tradition

Health secretaries and national NHS leaders are only stewards of a very precious and decades old tradition – that of the service’s middle tier, and its many reorgansiations.

When opportunity opens up and their time comes to reshuffle the authorities, acronyms and offices before them, they are constrained not only by the weight of history on their shoulders, but also by Nigel Edwards’ Law. Named after the current Nuffield Trust chief executive and long time health policy hero, the rule dictates that no reorganisation of the NHS middle tier may settle on a number that has ever previously been used.

Simon Stevens, Ian Dalton, Matthew Swindells and colleagues were thankfully mindful of their responsibilities as they thrashed out the latest iteration, disclosed in new proposals for the two organisations to work more closely together including in regional offices, with single director teams. They came dangerously close to, but thankfully narrowly avoided, the eight regional offices of the 1990s and instead settled on seven regional teams.

“Seven?! WTF!?” you might ask. These patches apparently have their genesis in informal arrangements used to split performance management duties between the regional directors during the winter just gone. They include London, the South West, and the South East – which are already operating in this way (sort of, a bit). Then the North of England will be carved in two (North East and North West? Surely it can’t be that simple); and the Midlands and East region similarly (East Midlands and West Midlands? But what to do with the patch formerly known as East of England?).

Any good re-disorganisation is painfully drawn out – our current stewards are doing pretty well on that front so far, and have left themselves until September to iron out the finer details.